Patients taking prescription drugs for chronic conditions received an average medication adherence grade of just C+, according to a report released by the National Community Pharmacists Association.
Americans who take prescription drugs for chronic conditions are falling short when it comes to medication adherence, according to a report released on June 25, 2013, by the National Community Pharmacists Association (NCPA). The report, titled “Medication Adherence in America: A National Report Card,” also finds that having a strong sense of personal connection with pharmacists is an important predictor of whether patients are adherent.

The report was based on a survey carried out by Langer Research Associates. It was conducted between February 20 and March 10, 2013, and included 1020 adults aged 40 and older who had been prescribed medications for a chronic condition. Participants were asked whether they had engaged in any of 9 non-adherent behaviors over the previous 12 months: failing to fill or refill a prescription, missing a dose, taking a lower or higher dose than prescribed, stopping taking a prescription early, taking an old medication for a new problem without consulting a doctor, taking someone else’s medication, or forgetting whether they had taken a medication. Participants were also asked questions about their relationships with health care providers and their attitudes toward their health and their prescription medications.

Participants’ adherence level was calculated on a scale of 0 (non-adherence on all 9 behaviors) to 100 (adherence on all 9 behaviors). Overall, 24% of respondents received an A grade for reporting complete adherence; another 24% received a B grade for being largely adherent, reporting on average 1 non-adherent behavior; 20% received a C grade for reporting an average of 2 non-adherent behaviors; 16% received a D grade for reporting an average of 3 non-adherent behaviors; and the remaining 15% were largely non-adherent and received an F grade, with an average of 4 or more non-adherent behaviors.

“Proper prescription drug use can improve patient health outcomes and lower health care costs, so anything less than an A on medication adherence is concerning,” said NCPA CEO B. Douglas Hoey, RPh, MBA, in a press release. “Pharmacists can help patients and caregivers overcome barriers to effectively and consistently follow medication regimens. Indeed, independent community pharmacists in particular may be well-suited to boost patient adherence given their close connection with patients and their caregivers.”

The most common forms of non-adherence reported by participants were missing a dose (57%), forgetting whether they had taken their medication (30%), failing to refill a prescription on time (28%), taking a lower dose than instructed (22%), and failing to refill a new prescription (20%). The most common reasons cited for non-adherence were forgetting to take medication (42%), running out of medication (34%), being away from home (27%), attempting to save money (22%), unpleasant side effects (21%), being too busy (17%), feeling that medication was not working (17%), believing that medication was not needed (16%), and disliking taking medication (12%).

Analysis of the participants’ responses found 6 key predictors of adherence: having a personal connection with one’s pharmacist or pharmacy staff; affordability of medications; level of continuity in health care; patients’ sense of the importance of taking medication exactly as prescribed; how well informed patients felt about their health; and the level of medications’ unpleasant side effects. These predictors suggest that adherence can be improved by creating a stronger personal connection between patients and pharmacy staff, increasing patients’ level of health information and awareness of the importance of adherence, and encouraging patients to discuss side effects when they occur.

Personal Connection With Pharmacy Staff
The 63% of respondents who reported that their pharmacist or pharmacy staff knew them “pretty well” had an average adherence grade of 80, compared with 77 for those without this sense of connectedness. The report authors note that this is a slight difference, but is statistically significant and that after controlling for other factors, a sense of connectedness with one’s pharmacist or pharmacy staff was the survey’s “single strongest individual predictor of medication adherence.”

The type of pharmacy that a patient used played a major role in determining whether they felt a strong sense of connectedness to its staff. Of mail-order pharmacy users, 36% reported that their pharmacist or pharmacy staff knew them pretty well, compared with 67% of chain pharmacy users and 89% of neighborhood pharmacy users.

The portion of patients who felt that the pharmacist or pharmacy staff knew them pretty well also increased with the duration of a prescription: 38% for those who received their first prescription within the last 2 years, 60% for those who had been prescribed a medication for 3 to 5 years, and 68% for those had been prescribed a medication for 6 years or longer. Patients’ sense of connectedness to pharmacy staff was slightly higher in the Midwest and Northeast than in other parts of the country and was higher in suburban and rural areas than in urban areas.

The results also indicate that pharmacists are less likely than doctors to speak with patients about new prescriptions: 77% of respondents said that their physicians always do so, compared with nearly 6 in 10 who say their pharmacist always does this—48% for mail-order pharmacy users and 61% for chain or independent pharmacy users. This suggests that there is room for improvement in the frequency with which pharmacists discuss new prescriptions with patients.

“Pharmacists have a role at the forefront of addressing prescription medication non-adherence,” write the report authors. “The results of this survey indicate that much depends on the extent to which pharmacists and pharmacy staff establish a personal connection with their customers and engage with them to encourage fuller understanding of the importance of taking medications as prescribed. Independent pharmacists may be particularly well-placed to boost adherence, given their greater personal connection with patients.”

Sense of Adherence Importance
For the half of respondents who considered it extremely important to take their medication exactly as prescribed, the average adherence score was 81, compared with 77 for those who saw this as less important. Patients were more likely to see adherence as important when they felt that their medication was helping them to live a better or longer life, when adherence was perceived as easy to achieve, when they had no concern about the long-term effects of medication, and when they felt a strong sense of personal connection with pharmacy staff. In addition, 55% of patients with hypertension said that following prescription instructions was extremely important, compared with 42% of those with other conditions.

Medication Affordability
Respondents who said it was very easy to afford their medications had an average adherence score of 83, compared with 74 for those who reported difficulty covering their medication costs.

Medication Side Effects
For the 3 in 10 respondents who reported having at least some unpleasant medication side effects, the average adherence score was 74, compared with 83 for the half of respondents who reported no unpleasant side effects.

Continuity of Care
Nearly 70% of respondents reported seeing the same health care provider for each doctor’s visit, and they had an average adherence score of 81, compared with an average of 75 for those who saw the same provider most of the time or less frequently.

Health Information Level
For the 8 in 10 respondents who reported feeling very informed about their health, the average adherence score was 80, compared with 74 for those who felt less informed.

Age
Older respondents were generally more adherent; those aged 50 and older had an average adherence score of 81, compared with 73 for those under 50.

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